RESUMEN
BACKGROUND: A high percentage of patients with chronic low back pain (LBP) do not adequately adhere to home exercise programs. There is no information regarding a possible association between patient independence in performing an exercise program and adherence to this exercise program. OBJECTIVE: To assess a possible association between patient independence in performing two different home exercise programs (treatment based on the Movement System Impairment-Based classification model (MSI) and treatment based on stretching and strengthening exercises for chronic LBP and adherence to those exercise programs. DESIGN: This was a secondary analysis of a randomized controlled trial. METHODS: The physical therapist assessed the patient's independence in performing the exercise program at the initial physical therapy sessions. Adherence was calculated during the 8-week treatment by the number of days performing the home exercise programs. Multivariate linear regression models were built to investigate whether patient independence in performing the home exercise program was associated with adherence to home exercise program for each treatment group adjusted for possible confounders (age, physical activity status, pain duration, pain intensity and disability at baseline). RESULTS: We observed a clinically important association between patient independence in performing the home exercise and adherence to a treatment based on the MSI model group (ßâ¯=â¯-15.6 days, 95%CIâ¯=â¯-24.5 to -6.7, R2â¯=â¯16%, pâ¯=â¯0.001). CONCLUSIONS: People with chronic LBP adhered more to a home exercise program based on the MSI model when they are more independent in performing the exercise program.
Asunto(s)
Dolor de la Región Lumbar , Ejercicio Físico , Terapia por Ejercicio , Humanos , Dolor de la Región Lumbar/terapia , Dimensión del Dolor , Cooperación del PacienteRESUMEN
Neck pain is a common condition with a high prevalence worldwide. Neck pain is associated with significant levels of disability and is widely considered an important public health problem. Neck pain is defined as pain perceived between the superior nuchal line and the spinous process of the first thoracic vertebra. In some types of neck conditions, the pain can be referred to the head, trunk and upper limbs. This article aims to provide an overview of the available evidence on prevalence, costs, diagnosis, prognosis, risk factors, prevention and management of patients with neck pain.
Asunto(s)
Dolor Agudo , Dolor Crónico , Dolor de Cuello , Manejo del Dolor , Dolor Agudo/diagnóstico , Dolor Agudo/economía , Dolor Agudo/epidemiología , Dolor Agudo/terapia , Adulto , Dolor Crónico/diagnóstico , Dolor Crónico/economía , Dolor Crónico/epidemiología , Dolor Crónico/terapia , Humanos , Dolor de Cuello/diagnóstico , Dolor de Cuello/economía , Dolor de Cuello/epidemiología , Dolor de Cuello/terapia , Manejo del Dolor/economía , Manejo del Dolor/métodosRESUMEN
STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST). SUMMARY OF BACKGROUND DATA: LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries. METHODS: This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire. RESULTS: A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP. CONCLUSION: Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis. LEVEL OF EVIDENCE: 2.
Asunto(s)
Dolor Agudo/epidemiología , Dolor Agudo/terapia , Personas con Discapacidad , Servicio de Urgencia en Hospital/tendencias , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/terapia , Dolor Agudo/diagnóstico , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Dolor de la Región Lumbar/diagnóstico , Masculino , Persona de Mediana Edad , Dimensión del Dolor/tendencias , Pronóstico , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
Low back pain (LBP) is extremely common and causes an enormous burden on the society. This perspective article aims to provide an evidence-based summary in the field of LBP. More specifically, we aimed to present epidemiological data on cost, diagnosis, prognosis, prevention and interventions for patients with LBP. It is critical that both clinicians and policymakers follow best practices by using high-value care for patients with LBP. In addition, nonevidence-based procedures must be immediately abandoned. These actions are likely to reduce societal costs and will improve the quality of life of these patients.
Asunto(s)
Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/terapia , Manejo del Dolor/métodos , Humanos , Dolor de la Región Lumbar/diagnóstico , Factores de RiesgoRESUMEN
BACKGROUND: Kinesio taping is a commonly used intervention for patients with chronic low back pain. However, the medium term effects of kinesio taping in these patients are unknown. OBJECTIVE: To investigate the effectiveness of kinesio taping in patients with chronic low back pain after 6 months from randomization. METHODS: This was a randomized controlled trial with a 6 months follow up. One hundred and forty eight participants were randomly assigned to the experimental (kinesio taping with skin convolutions) or control (kinesio taping without convolutions-Sham Taping) group. Participants from both groups had the tape reapplied twice a week for four weeks. The outcomes were pain, disability and global impression of recovery after 6 months. RESULTS: One participant was lost to follow up in the experimental group (n=73, response rate 99%) and two in the control group (n=72, response rate 97%). After 6 months there were no statistically significant between-group differences in pain intensity (between-group difference -0.8 points, 95% CI -1.7 to 0.2), global impression of recovery (0.4, -0.7 to 1.5), or disability (-1.1, -3.0 to 0.7). CONCLUSION: Four weeks of kinesio taping treatment was no better than sham taping for patients with chronic low back pain, at 6 months follow-up. Trial Registration Number (http://www.ensaiosclinicos.gov.br/): RBR-7ggfkv (Brazilian Registry of Clinical Trials).
Asunto(s)
Cinta Atlética , Dolor de la Región Lumbar/terapia , HumanosRESUMEN
INTRODUCTION: Meta-epidemiological studies examining the influence of methodological characteristics, such as allocation concealment and intention-to-treat analysis have been performed in a large number of healthcare areas. However, there are no studies investigating these characteristics in physical therapy interventions for patients with low back pain. The aim of this study is to investigate the influence of allocation concealment and the use of intention-to-treat analysis on estimates of treatment effects of physical therapy interventions in low back pain clinical trials. METHODS AND ANALYSIS: Searches on PubMed, Embase, Cochrane Database of Systematic Reviews, Physiotherapy Evidence Database (PEDro) and CINAHL databases will be performed. We will search for systematic reviews that include a meta-analysis of randomised controlled trials that compared physical therapy interventions in patients with low back pain with placebo or no intervention, and have pain intensity or disability as the primary outcomes. Information about selection (allocation concealment) and attrition bias (intention-to-treat analysis) will be extracted from the PEDro database for each included trial. Information about bibliographic data, study characteristics, participants' characteristics and study results will be extracted. A random-effects model will be used to provide separate estimates of treatment effects for trials with and without allocation concealment and with and without intention-to-treat analysis (eg, four estimates). A meta-regression will be performed to measure the association between methodological features and treatment effects from each trial. The dependent variable will be the treatment effect (the mean between-group differences) for the primary outcomes (pain or disability), while the independent variables will be the methodological features of interest (allocation concealment and intention-to-treat analysis). Other covariates will include sample size and sequence generation. ETHICS AND DISSEMINATION: No ethical approval will be required for this study. The study findings will be published in a peer-reviewed journal and presented at international conferences. REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (CRD42016052347).
Asunto(s)
Estudios Epidemiológicos , Análisis de Intención de Tratar , Dolor de la Región Lumbar/terapia , Modalidades de Fisioterapia/normas , Sesgo , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de InvestigaciónRESUMEN
OBJECTIVE: To describe the pattern of injuries and illnesses sustained during the Games of the XXXI Olympiad, hosted by Rio de Janeiro from 5 to 21 August 2016. METHODS: We recorded the daily incidence of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Rio 2016 medical staff. RESULTS: In total, 11 274 athletes (5089 women, 45%; 6185 men, 55%) from 207 NOCs participated in the study. NOC and Rio 2016 medical staff reported 1101 injuries and 651 illnesses, equalling 9.8 injuries and 5.4 illnesses per 100 athletes over the 17-day period. Altogether, 8% of the athletes incurred at least one injury and 5% at least one illness. The injury incidence was highest in BMX cycling (38% of the athletes injured), boxing (30%), mountain bike cycling (24%), taekwondo (24%), water polo (19%) and rugby (19%), and lowest in canoe slalom, rowing, shooting, archery, swimming, golf and table tennis (0%-3%). Of the 1101 injuries recorded, 40% and 20% were estimated to lead to ≥1 and >7 days of absence from sport, respectively. Women suffered 40% more illnesses than men. Illness was generally less common than injury, with the highest incidence recorded in diving (12%), open-water marathon (12%), sailing (12%), canoe slalom (11%), equestrian (11%) and synchronised swimming (10%). Illnesses were also less severe; 18% were expected to result in time loss. Of the illnesses, 47% affected the respiratory system and 21% the gastrointestinal system. The anticipated problem of infections in the Rio Olympic Games did not materialise, as the proportion of athletes with infectious diseases mirrored that of recent Olympic Games (3%). CONCLUSION: Overall, 8% of the athletes incurred at least one injury during the Olympic Games, and 5% an illness, which is slightly lower than in the Olympic Summer Games of 2008 and 2012.
Asunto(s)
Traumatismos en Atletas/epidemiología , Enfermedades Gastrointestinales/epidemiología , Enfermedades Respiratorias/epidemiología , Aniversarios y Eventos Especiales , Atletas , Brasil , Femenino , Humanos , Incidencia , Masculino , Estudios ProspectivosRESUMEN
QUESTIONS: What is the incidence of running-related injuries (RRIs) in recreational runners? Which personal and training characteristics predict RRIs in recreational runners? DESIGN: Prospective cohort study. PARTICIPANTS: A total of 200 recreational runners answered a fortnightly online survey containing questions about their running routine, races, and presence of RRI. These runners were followed-up for a period of 12 weeks. OUTCOME MEASURES: The primary outcome of this study was running-related injury. The incidence of injuries was calculated taking into account the exposure to running and was expressed by RRI/1000 hours. The association between potential predictive factors and RRIs was estimated using generalised estimating equation models. RESULTS: A total of 84 RRIs were registered in 60 (31%) of the 191 recreational runners who completed all follow-up surveys. Of the injured runners 30% (n=18/60) developed two or more RRIs, with 5/18 (28%) being recurrences. The incidence of RRI was 10 RRI/1000 hours of running exposure. The main type of RRI observed was muscle injuries (30%, n=25/84). The knee was the most commonly affected anatomical region (19%, n=16/84). The variables associated with RRI were: previous RRI (OR 1.88, 95% CI 1.01 to 3.51), duration of training although the effect was very small (OR 1.01, 95% CI 1.00 to 1.02), speed training (OR 1.46, 95% CI 1.02 to 2.10), and interval training (OR 0.61, 95% CI 0.43 to 0.88). CONCLUSIONS: Physiotherapists should be aware and advise runners that past RRI and speed training are associated with increased risk of further RRI, while interval training is associated with lower risk, although these associations may not be causative.
Asunto(s)
Traumatismos en Atletas/epidemiología , Extremidad Inferior/lesiones , Acondicionamiento Físico Humano , Carrera/lesiones , Traumatismos Vertebrales/epidemiología , Adulto , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
INTRODUCTION: Chronic low back pain is a common condition. A new intervention that is popular in sports has been used in patients with low back pain. This technique is based on the use of elastic tapes that are fixed on the skin of patients using different tensions and is named Kinesio Taping Method. Although this intervention has been widely used, to date the evidence of its effectiveness is lacking. RESEARCH QUESTION: Is the application of the Kinesio Taping Method according to the treatment manual (with convolutions in neutral position) more efficacious than a simple application without convolutions in patients with chronic low back pain? DESIGN: Two-arm randomised controlled trial with a blinded assessor. PARTICIPANTS AND SETTING: 148 patients with chronic low back pain from two outpatient physiotherapy clinics in Brazil. INTERVENTION: 8 sessions of Kinesio Taping according to the Kinesio Taping Method treatment manual (ie, 10-15% tension with the treated muscles in stretching position and with convolutions in neutral). CONTROL: 8 sessions of Kinesio Taping having no convolutions in neutral (0% tension) with the treated muscles in resting position. MEASUREMENTS: Clinical outcomes (pain intensity, disability and global impression of recovery) will be obtained in assessments that will be performed at 4 weeks and 3 months after randomisation. ANALYSIS: The effects of the intervention will be calculated through linear mixed models following intention-to-treat principles. DISCUSSION: This is the largest study aimed to investigate the hypothesised mechanism behind the Kinesio Taping application in patients with chronic low back pain. The results of this study will contribute to a better understanding about the mechanisms of action of this widely applied therapeutic modality. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials. REGISTRATION NUMBER: RBR-7ggfkv. PROSPECTIVE REGISTRATION: Yes. FUNDED BY: Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP), and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil. APPROVAL NUMBER: FAPESP number 2011/12926-0; CNPq number 470652/2011-0. ANTICIPATED COMPLETION: February 2013. CORRESPONDENCE: Leonardo Oliveira Pena Costa, Rua Cesário Galeno 448, Tatuapé, São Paulo/SP, Brazil 03071-000 Email: lcos3060@gmail.com FULL PROTOCOL: Available on the eAddenda at jop.physiotherapy.asn.au.
Asunto(s)
Cinta Atlética , Dolor de la Región Lumbar/terapia , Enfermedad Crónica , Humanos , Método Simple CiegoRESUMEN
OBJECTIVES: To investigate whether the methodological quality is influenced by language of publication in reports of randomized controlled trials and controlled clinical trials of physiotherapy interventions. STUDY DESIGN AND SETTING: Bibliometric and methodological quality data from all reports of trials indexed on the Physiotherapy Evidence Database (PEDro) up to February 2011 were extracted. Descriptive statistics on the total PEDro score and the 11 individual PEDro items were calculated for each language of publication and for all non-English-language reports combined. Regression models were calculated to predict the total PEDro score and the presence of each of the 11 items of the PEDro scale using the language of publication as an independent variable. RESULTS: A total of 13,392 reports of trials were used for this study, 12,532 trials published in English and 860 published in other languages. Overall methodological quality was better for English reports than reports written in other languages (ß = 0.15, 95% confidence interval = 0.04, 0.25). Specifically, reporting was better for items relating to random allocation, concealed allocation, and blinding of assessors, worse for more than 85% follow-up and intention-to-treat analysis, and no different for eligibility criteria and source specified, baseline comparability, blinding of subjects and therapists, reporting of between-group statistical comparisons, and reporting of point measures and measures of variability. CONCLUSION: Language of publication is associated with the methodological quality of reports of physiotherapy trials. Although English reports are more likely to have better methodological quality than reports written in other languages, the magnitude of this influence is small.
Asunto(s)
Publicaciones Periódicas como Asunto/normas , Modalidades de Fisioterapia/normas , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Sesgo , Bibliometría , Humanos , LenguajeRESUMEN
OBJECTIVE: Chronic pain is a common problem that is associated with mood disorders such as depression. The Depression, Anxiety, and Stress Scales (DASS-21) questionnaire is commonly used to help measure disordered mood. In this study, we used Rasch analysis to analyze the clinimetric properties of the DASS-21 in a chronic low back pain sample. STUDY DESIGN AND SETTING: A Rasch analysis was conducted on data collected as a part of a randomized hospital-based placebo-controlled trial. DASS-21 questionnaires were completed by the 154 enrolled participants. RESULTS: The DASS-21 subscales fit the Rasch model. No differential item functioning was detected for age, gender, pain severity, or disability. Reliability for individual use was supported for the depression subscale (Person Separation Index [PSI]=0.86) but group use only for the anxiety (PSI=0.74) and stress (PSI=0.82) subscales. A DASS-21 aggregate score of "negative affect" lacked fit to the Rasch model (χ(2)=191.48, P<0.001). CONCLUSION: This is the first study that used Rasch analysis to demonstrate that the DASS-21 subscales demonstrate adequate measurement properties for research involving groups with chronic pain. Only the DASS-21 depression subscale demonstrated adequate reliability for use with individuals with chronic pain. The use of a single DASS-21 aggregate score as a measure of "negative affect" was not supported.